IgG4-related autoimmune pancreatitis complicated by splenic artery pseudoaneurysm

Three cases of IgG4-RD complicated by splenic artery aneurysm: a complication of IgG4-RD?

Immunoglobulin 4-related disease (IgG4-RD) is known for its potential to affect nearly every organ, particularly a preference for large and middle-sized arteries when vascular involvement occurs. However, instances of splenic artery aneurysms are exceedingly rare with only two cases reported in the literature. We have summarised the clinical manifestations and laboratory characteristics of the three patients we reported along with the two patients previously reported. It is noteworthy that all five patients had involvement of the salivary glands and only one patient had other arterial involvement. The three patients we reported had no new organ onset or worsening of existing organ involvement and normal or not significantly elevated serum IgG4 levels when the artery aneurysm was identified. These aneurysms may be the result of vascular damage from prior involvement that was not recognised previously. The cases we reported here highlight a potential association between IgG4-RD and concurrent splenic artery aneurysms.

Arterial Pseudoaneurysm within a Pancreatic Pseudocyst

The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic management by angioembolization to prevent critical bleeding. A 67-year-old male with a history of chronic pancreatitis presented with severe acute abdominal pain and vomiting to the emergency department. Seven weeks prior to the present admission, a CT scan had displayed a pancreatic pseudocyst with a maximum diameter of 53 mm. A laboratory examination revealed an elevated white blood cell count (15.40 × 103/μL), as well as elevated serum lipase (191 U/L), bilirubin (1.48 mg/dL), and blood glucose (353 mg/dL) levels. Sonographically, the previously described pancreatic pseudocyst revealed a slightly increased maximum diameter of 65 mm and an inhomogeneous echo of the cystic content. A contrast-enhanced CT scan showed a further increase in maximum diameter to 70 mm of the known pseudocyst. Inside the pseudocyst, a pseudoaneurysm originating from the splenic artery with a maximum diameter of 41 mm was visualized. After interdisciplinary consultation, prophylactic coil embolization of the splenic artery was immediately performed. The pseudoaneurysm was shut off from blood supply by back-door/front-door occlusion employing 27 coils, resulting in complete exclusion of the pseudoaneurysm from the circulation. Pseudoaneurysms are a rare complication of acute and chronic pancreatitis which has been shown to be efficiently treated by coil embolization.